Review article
Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: A systematic review

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Introduction: Our objective was to evaluate the capability of lateral cephalograms in diagnosing hypertrophied adenoids and obstructed posterior nasopharyngeal airways. Methods: A systematic review of the literature by using several electronic databases (Cochrane Library, Medline, Medline in progress, PubMed, Web of Science, Embase, and Lilacs) was performed with the help of a senior health-sciences librarian. The electronic search was followed up with hand searches. After applying our inclusion-exclusion criteria, the search yielded 11 articles that were then scored based on their methodological validity. Results: Lateral cephalograms performed reasonably well in evaluating adenoid size; both quantitative measures of adenoid area and subjective grading of adenoid size on lateral cephalograms had reasonable correlations to actual adenoid size (range of r, 0.60 to 0.88). However, evidence suggested that cephalograms were less ideal for evaluating the size of the posterior nasopharyngeal airway. The diagnostic difference is likely because the adenoid is a simpler 3-dimensional structure than the nasopharynx; therefore, it loses less information when compressed into 2 dimensions by the radiograph. Conclusions: Being used as a screening tool to determine the need for more rigorous ENT follow-up appears to be the greatest utility of lateral cephalograms. Because no consensus could be reached on what are the most useful landmarks, we recommend that clinicians look for multiple deviant measures of adenoid size rather than one definitive quantification.

Section snippets

Material and methods

To ensure that the search was sensitive to all articles pertaining to our question, we used a truncation of the word “nasopharynx” rather than only “adenoid” to help improve the probability of including any study that focused on the anatomical location in question. We then combined “nasopharynx” with truncated forms of “cephalogram” and “cephalometric” to find articles pertaining to the diagnostic procedure in question. The truncated forms of these terms are listed in Table I. Both the

Results

Our search yielded 11 articles (Table IV) that met the inclusion criteria (Table II).15, 18, 25, 26, 27, 28, 29, 30, 31, 32, 33 The numbers of articles found in each database during our initial search, first phase selection, and final selection meeting the inclusion criteria are given in Table I. Articles that were nearly accepted but in the end rejected are listed in Table V.

Once the articles were selected, we systematically assigned a methodological score to each study to order them in their

Discussion

Because of the relatively high frequency and potential orthodontic consequences of nasopharyngeal obstruction, it is important to have a simple, economical, readily available, and reproducible way to diagnose upper airway obstruction. We performed a systematic review of the literature to determine the capabilities of lateral cephalograms in diagnosing enlarged adenoids and obstructed upper airways. We found 11 studies that met the criteria. In general, the conclusions of these studies depended

Conclusions

  • No conclusive evidence was found. All selected studies had some methodological deficiency. Better designed studies with adequate sensitivity-specificity analysis, including receiver-operating characteristic curves should be performed and 3D imaging used as the diagnostic gold standard.

  • Cephalograms seem to reliably image the adenoid but are less dependable for diagnosing nasopharyngeal size.

  • No consensus for landmarking procedures was found; NcNamara’s line was the only specific measurement with

References (50)

  • W.D. Jeans et al.

    How should adenoidal enlargement be measured?A radiological study based on interobserver agreement

    Clin Radiol

    (1981)
  • P.S. Vig et al.

    Sensitivity and specificity of diagnostic tests for impaired nasal respiration

    Am J Orthod Dentofacial Orthop

    (1991)
  • D. Wang et al.

    Fiberoptic examination of the nasal cavity and nasopharynx in children

    Int J Pediatr Otorhinolaryngol

    (1992)
  • R.J. Schwab et al.

    Upper airway assessment: radiographic and other imaging techniques

    Otolaryngol Clin North Am

    (1998)
  • D.I. Filho et al.

    A comparison of nasopharyngeal endoscopy and lateral cephalometric radiography in the diagnosis of nasopharyngeal airway obstruction

    Am J Orthod Dentofacial Orthop

    (2001)
  • J. Mah et al.

    Three-dimensional craniofacial imaging

    Am J Orthod Dentofacial Orthop

    (2004)
  • E.T. Parks

    Computed tomography applications for dentistry

    Dent Clin North Am

    (2000)
  • W.M. Montgomery et al.

    Computed tomography: a three-dimensional study of the nasal airway

    Am J Orthod

    (1979)
  • G.F. Dunn et al.

    Relationships between variation of mandibular morphology and variation of nasopharyngeal airway size in monozygotic twins

    Angle Orthod

    (1973)
  • S. Linder-Aronson et al.

    Radiocephalometric analysis of anteroposterior nasopharyngeal dimensions in 6- to 12-year-old mouth breathers compared with nose breathers

    ORL J Otorhinolaryngol Relat Spec

    (1973)
  • S. Linder-Aronson

    AdenoidsTheir effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the denition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids

    Acta Otolaryngol

    (1970)
  • Y. Finkelstein et al.

    Frontal and lateral cephalometry in patients with sleep-disordered breathing

    Laryngoscope

    (2001)
  • M.M. Ozbek et al.

    Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults

    Eur J Orthod

    (1998)
  • P.S. Vig et al.

    The inadequacy of cephalometric radiographs for airway assessment (letter)

    Am J Orthod

    (1980)
  • G.T. Kluemper et al.

    Nasorespiratory characteristics and craniofacial morphology

    Eur J Orthod

    (1995)
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